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Objectives: Digital interventions are increasingly used to support behaviour change. In the prevention of chronic work-related skin diseases, the sustainable implementation of appropriate skin protection behaviour following tertiary individual prevention is important. However, there exists no intervention to support the maintenance of these behaviour changes until now. We report the systematic development of a technology-based maintenance programme to support patients to sustainably implement skin protection behaviour and to overcome barriers. Design: Complex intervention development based on a five-step multi-methods process. Setting: Tertiary individual prevention of work-related skin disease in Germany. Methods: Intervention development comprised the following steps--literature review, qualitative focus groups with stakeholders, quantitative assessment of the patients' needs, development of a programme theory, and intervention development and concept validation. Results: We developed a concept for a complex intervention based on results from the literature review, with seven reviews meeting the criteria; qualitative focus groups involving three dermatologists, five health educators, two psychologists and three employees of an accident insurance institution; and a quantitative needs assessment with 72 patients. Key requirements were derived from this process: for example, the need to develop an app to self-monitor skin protection behaviour and skin condition and to inform the individual about ways of dealing with barriers encountered during the uptake and maintenance of skin protection behaviour. In addition, patients will participate in an individual goal-setting exercise to identify individual behavioural goals. Conclusion: A technology-based approach to the prevention of work-related skin diseases was developed. During the process of development, the perspectives of relevant stakeholders and the target group were considered in a participatory way.

Tertiary Individual Prevention is an interprofessional inpatient rehabilitation programme offered to workers affected by work-related skin diseases. Health educational interventions aiming at changing skin protection behaviour are a pivotal component of the programme. This paper aims at characterizing the content of the educational interventions of the interprofessional inpatient rehabilitation programme and at reporting the mechanisms and functions for behaviour change. We retrospectively analysed existing health educational interventions with document analyses and field observations. The intervention was described using the Template of Intervention Description and Replication (TIDieR). For the intervention content, the Behaviour Change Technique (BCT) Taxonomy (v1) was applied. To characterize the intervention in detail, the BCTs were then mapped to the intervention functions, the COM-B model (Capability, Opportunity, Motivation) and the Theoretical Domains Framework (TDF) from the Behaviour Change Wheel (BCW). The health educational interventions consist of seven components. Five are delivered in a group and two as tailored face-to-face counselling. We identified 23 BCTs in 10 groups. The most common used BCTs are "instruction on how to perform skin protection behaviour," "salience of consequences," "information about skin health," and "demonstration of skin protection behaviour." To initiate the process of behaviour change in skin protection behaviour by the individuals, changes are required in all three behavioural sources (Capability, Opportunity, Motivation) and primarily in the theoretical constructs "behavioural regulation," "skills," and "beliefs about consequences." For this purpose, the five intervention functions "enablement," "training," "education," "modelling," and "persuasion" are used. Health educational interventions to change skin protection behaviour consists of different BCTs, mechanisms of change and intervention functions. This work helps to better understand the mechanisms and means of behaviour change and enables replication in other settings. In the future, the intervention programme should be extended to include BCTs addressing domains for behaviour changes which have not yet been included to maintain the new behaviour in the long-term. Finally, we recommend to report more elements of the rehabilitation programme (e.g. psychological interventions) in a standardized manner by frameworks used in this paper. [ABSTRACT FROM AUTHOR]

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Summary: Background and objectives: Outdoor workers are at increased risk of developing non‐melanoma skin cancer. We aimed to address the lack of validated German‐language measurement instruments for outdoor workers' sun safety behavior and knowledge by compiling and validating two questionnaires. Participants and methods: By expert consensus, items for the assessment of protective behavior (OccuSun) were compiled based on existing instruments. For knowledge, a translation of the Skin Cancer and Sun Knowledge (SCSK) scale was selected. After a pre‐test, a validation study including 68 outdoor workers (62% female) was conducted in 2020. Results: The retest reliability was r = 0.93 (95% confidence interval: 0.86–0.96) for the protection score and rs = 0.78 (0.67–0.86) for the knowledge score. Protective behaviors were correlated with respective diary data (0.38 ≤ rs ≤ 0.74, p < 0.001) and skin pigmentation changes (–0.23 ≥ rs ≥ –0.42, 0.007 ≤ p ≤ 0.165) but not with self‐reported sunburn frequency (0.21 ≥ rs ≥ –0.04). Conclusions: Among German outdoor workers, two questionnaires for the assessment of sun protection behavior (OccuSun) and knowledge (SCSK) demonstrated good reliability. The OccuSun had generally good validity. Both instruments are fit for subsequent validation to determine their sensitivity to change. [ABSTRACT FROM AUTHOR]

Background: A programme based on health education has been developed to prevent foot dermatoses (FD) in patients with work‐related skin diseases (WRSD). Objective: To evaluate the effectiveness of the programme in a prospective cohort study (OCCUPES). Methods: Six and 12 months after completing the programme, follow‐up questionnaires were sent to 231 patients with WRSD and FD. Assessments included occupational footwear and foot care, self‐reported disease course, and health‐related quality of life. Results: Response to follow‐ups was >70%. Wearing functional socks and changing footwear and socks during one work shift increased (all p < 0.001). Complaints about occupational footwear decreased, including sweating and exposure to moisture/wetness. More than 60% reported improved FD while quality of life significantly increased. After 12 months, all foot symptoms were less frequent, including itch (p = 0.009), pain when walking (p = 0.005), pain in rest (p = 0.015) and smell (p = 0.001). The programme received very good ratings by the participants. Conclusions: The intervention was effective in improving occupational footwear, foot care and preventive behaviour. It resulted in a reduced burden of FD and should be implemented in the general care of patients with WRSD. [ABSTRACT FROM AUTHOR]

Background: Programmes for prevention of hand dermatoses in patients with work‐related skin diseases (WRSD) are well established. Similar interventions for foot dermatoses (FD) are widely missing. Objective: To evaluate the effectiveness of a programme for prevention of FD based on health education in patients with WRSD while investigating the impact and possible causative factors of FD. Methods: In a prospective cohort study (OCCUPES), 231 patients with WRSD and FD participating in the programme were recruited. The skin was examined and questionnaires were completed, including assessment of footwear, FD severity, symptoms and health‐related quality of life. Results: The baseline and some early results are presented. A work‐related causation of FD was likely in 60 patients (26.0%) with irritant contact dermatitis being the most frequent diagnosis. Work‐related FD were associated with male sex (p = 0.012), sweating in footwear (p = 0.004) and wearing of safety footwear (p = 0.013). FD were often long‐lasting with a high degree of work‐absenteeism, quality of life impairment, itch and pain, particularly in work‐related FD. Conclusions: Interventions are needed to reduce the burden of FD in patients with WRSD. The programme addresses current shortcomings in prevention of FD. A long‐term evaluation of its effectiveness follows. [ABSTRACT FROM AUTHOR]

Background: Semipermeable membranes might be suitable for glove liners or comfort gloves in individuals with irritant contact dermatitis (ICD). Objectives: To evaluate the effects of different glove materials on inflammation and epidermal barrier impairment after experimental skin irritation. Methods: Nine test areas on the volar forearms of 24 healthy volunteers were irritated with sodium lauryl sulfate (1%) and afterward covered for 6 days (6 or 8 h/day) with semipermeable Sympatex (SYM), vinyl (OCC), combinations of vinyl with Sympatex (SYM/OCC) or cotton (COT/OCC), or left uncovered (CON). Up to day 10, measurements of transepidermal water loss (TEWL), erythema (a*), skin humidity (SH) and visual scoring (VS) were applied. Results: No significant differences in skin parameters were found between COT/OCC and SYM/OCC as well as between each of the combinations and CON. SYM, COT/OCC and SYM/OCC led to better results for most skin parameters than OCC alone. Conclusions: Occlusive material has a negative impact on skin barrier recovery and inflammation after skin irritation whereas SYM is not inferior to uncovered areas indicating good tolerability. Altogether, the data suggest that SYM is a useful alternative to COT as material for glove liners and comfort gloves in ICD patients. [ABSTRACT FROM AUTHOR]

Background: Occupational skin diseases (OSD) in the form of hand eczema (HE) are a common work-related disease. Illness perceptions as presented in Leventhal's Common-Sense Model (CSM) are important for patients' self-management of diseases. Understanding these illness perceptions is essential for patient communicating. No quantitative or qualitative studies which investigated subjective illness perceptions in patients with occupational HE utilized the CSM as theoretical framework. The Objective of this study is to investigate illness perceptions of patients with occupational hand eczema (HE) using the CSM. Methods: We applied an exploratory qualitative approach and conducted purposive sampling. Thirty-six patients with occupational HE were interviewed using an interview guide based on the dimensions of the CSM, including coherence and emotional representation. All participants participated in a three-week inpatient program at a clinic specialized on occupational dermatology. One interview had to be excluded before analysis, since one participant's diagnosis was retrospectively changed from ICD to tinea and hence did not match the inclusion criteria. Thirty-five interviews were transcribed verbatim and analyzed. Data was analyzed deductively and inductively using qualitative text analysis. MAXQDA 2018 (Verbi, Berlin, Germany), a software for qualitative data analysis, was applied for coding and summarizing of results. All dimensions of the CSM were explored for occupational HE. Results: Several sub-categories could be identified. Participants named a variety of causes in different areas (e. g. external irritants and other hazardous factors, psycho-social factors, allergies, having a 'bad immune system' or lifestyle). The great impact of the disease on the participants' life is shown by the wide range of consequences reported, affecting all areas of life (i. e. psychological, physical, occupational, private). Considering coherence, an ambivalence between comprehensibility and non-comprehensibility of the disease is apparent. Discussion: The complexity of illness perceptions presented in this paper is relevant for those involved in HE patient education and counseling, e. g, health educators, dermatologists, and, occupational physicians. Future research might further investigate specific aspects of illness perceptions in patients with occupational HE, especially considering the complexity of coherence and overlapping dimensions (i. e. emotional representation and psychological consequences). [ABSTRACT FROM AUTHOR]

Objectives: Digital interventions are increasingly used to support behaviour change. In the prevention of chronic work-related skin diseases, the sustainable implementation of appropriate skin protection behaviour following tertiary individual prevention is important. However, there exists no intervention to support the maintenance of these behaviour changes until now. We report the systematic development of a technology-based maintenance programme to support patients to sustainably implement skin protection behaviour and to overcome barriers. Design: Complex intervention development based on a five-step multi-methods process. Setting: Tertiary individual prevention of work-related skin disease in Germany. Methods: Intervention development comprised the following steps: literature review, qualitative focus groups with stakeholders, quantitative assessment of the patients' needs, development of a programme theory, and intervention development and concept validation. Results: We developed a concept for a complex intervention based on results from the literature review, with seven reviews meeting the criteria; qualitative focus groups involving three dermatologists, five health educators, two psychologists and three employees of an accident insurance institution; and a quantitative needs assessment with 72 patients. Key requirements were derived from this process: for example, the need to develop an app to self-monitor skin protection behaviour and skin condition and to inform the individual about ways of dealing with barriers encountered during the uptake and maintenance of skin protection behaviour. In addition, patients will participate in an individual goal-setting exercise to identify individual behavioural goals. Conclusion: A technology-based approach to the prevention of work-related skin diseases was developed. During the process of development, the perspectives of relevant stakeholders and the target group were considered in a participatory way. [ABSTRACT FROM AUTHOR]

Background: Semipermeable gloves might be an alternative to cotton gloves in management of hand dermatoses. Objectives: To compare acceptance and tolerability of gloves made of cotton or a semipermeable Sympatex membrane in patients with hand dermatoses and their effect on skin lesions when worn overnight. Methods: A total of 199 patients with work‐related symmetrical hand dermatoses were asked to wear a cotton glove (COT) on one hand and a Sympatex glove underneath a cotton glove (SYM/COT) on the other hand for 19 consecutive nights. The severity of skin lesions was regularly examined. A questionnaire on acceptance and tolerability was used in a subset of 126 patients. Results: Data on skin lesions were available for 183 participating patients (92%). The severity did not differ substantially between hands covered with SYM/COT or COT over time. Questionnaire data were available for 120 patients (95%). SYM/COT received better ratings regarding climate conditions while COT showed superiority in wearing comfort, practicality and appearance. Conclusions: Both SYM/COT and COT were well tolerated and accepted in patients with hand dermatoses. Hence, SYM/COT may serve as suitable alternative for COT as comfort gloves supporting therapeutic efforts. The observed slight differences may influence the decision when selecting the glove type. [ABSTRACT FROM AUTHOR]

In Germany, a stepwise multidisciplinary approach has been established to prevent occupational skin diseases (OSDs), primarily occupational contact dermatitis. This review aims to perform a systematic evaluation of the short‐ and long‐term effects of the German secondary and tertiary individual prevention programmes (SIP and TIP, respectively) for OSDs. Primary outcomes were continuation of employment, severity of hand dermatitis, and quality of life (QoL). The PubMed and Embase databases were searched for studies reporting the effects of the SIP and TIP. A total of 19 studies encompassing 5527 patients with OSDs were included: 11 studies evaluated the SIP and 8 evaluated the TIP. Following the SIP, approximately 70% to 90% and 60% to 70% of patients remained in their occupation after 1 and 5 years, respectively. At 3 years after the TIP, 82.7% of patients remained in their occupation and exhibited a significant decrease in hand dermatitis severity, as well as an increase in QoL. Most of these studies were uncontrolled and the interventions, outcomes, and measurement instruments used were heterogeneous. The SIP and TIP lead to decreased disease severity, improved QoL, and enabled most patients to continue working in their chosen professions. Implementing a similar multidisciplinary approach across Europe may be beneficial. [ABSTRACT FROM AUTHOR]

Background: Glove liners (GLs) made of cotton (COT) are worn under impermeable gloves to prevent occlusion effects. Semipermeable GLs made of Sympatex (SYM) might be an alternative. Objectives: To evaluate the acceptance of GLs (COT/SYM) in health care workers (HCWs) with work‐related skin diseases (WRSDs). Methods: One hundred sixty‐one HCWs with WRSDs were asked to wear GLs in combination with occlusive gloves for 10 ±2 weeks under workplace conditions. A questionnaire was applied to compare acceptance and usability of the respective glove combinations and previously used protective gloves (PUGs). Results: A total of 120 data sets were available (SYM: n = 65, 77.4%; COT: n = 55, 71.4%). Both GLs provided a significantly lower sweating sensation, more pleasant climate, comfortable wearing experience, and moist or dry feeling on the skin compared to PUGs. SYM‐GLs performed significantly better than COT‐GLs regarding mobility of hands, sensitivity, and sense of touch. COT‐GLs were significantly better than SYM‐GLs in the categories fit, donning and doffing, and material contact. Conclusions: Both GLs did not impair work performance, were applicable in various areas of health care activities, and were preferred over PUGs. Our results indicate that SYM‐GLs are an alternative to COT‐GLs and thus may contribute to current prevention strategies. [ABSTRACT FROM AUTHOR]

Background: In Germany, a multistep approach has been established to prevent work‐related skin diseases (WRSDs). Objectives: To evaluate the effect of a secondary individual prevention program (SIP) in metalworkers with WRSD and to compare their characteristics with those of participants of a tertiary individual prevention program (TIP). Patients and Methods: In a prospective cohort study, metalworkers with WRSD of the hands participating either in the SIP (n = 114) or in the TIP (n = 83) were recruited. At baseline and at the respective follow‐up 8–12 weeks after the SIP or at dismissal from the TIP (3–4 weeks later), questionnaires were completed and the severity of WRSD was assessed. Saliva samples were collected for assessment of filaggrin (FLG) mutations and an explorative genome‐wide association study (GWAS). Results: Ninety‐three SIP patients (81.6%) attended the follow‐up. Disease severity was significantly reduced, and knowledge and protective behavior were significantly improved compared to baseline. Significant differences between SIP and TIP patients were found regarding duration and severity of symptoms, work absenteeism, tobacco smoking, and presence of atopic dermatitis, but not regarding FLG mutations and by GWAS. Conclusions: The SIP was effective in metalworkers with WRSDs. Individual factors may influence the course of the disease and the need for the TIP. [ABSTRACT FROM AUTHOR]

Background: Metal work apprentices (MWAs) frequently develop work‐related hand eczema (HE). Objectives: To evaluate the effect of health education on incidence of work‐related HE in MWAs and to assess confounding factors. Materials/methods: In a prospective controlled intervention study, 131 MWAs received educational training on prevention of HE, whereas 172 MWAs and 118 office work apprentices served as controls. At baseline and during three yearly follow‐ups, questionnaires were completed and hands were examined. Saliva samples were collected for assessment of filaggrin (FLG) null mutations and an explorative genome‐wide association study (GWAS), and levels of various cytokines were assessed from stratum corneum samples. Results: The 2‐year and 3‐year incidence of HE in the metalwork control group was 20.9% and 32.6%, respectively, which was significantly higher than in the intervention group (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.31 to 5.28, P <.01 and OR 3.47, 95% CI 1.88 to 6.40, P <.0001). The knowledge score was higher in unaffected MWAs (P <.05). Other factors significantly associated with developing HE in MWAs were smoking cigarettes (P <.01) and FLG mutations (P <.001). No significant associations were found regarding epidermal cytokine levels and GWAS. Conclusions: Health education is effective in primary prevention of HE in MWAs. Individual factors should be considered in targeted counseling. [ABSTRACT FROM AUTHOR]

Objectives: Since January 2015, squamous cell carcinoma or multiple actinic keratosis of the skin caused by natural ultraviolet irradiation (UVR) is recognized as occupational disease in Germany. Interventions which improve the sun protection behavior of outdoor workers are urgently needed. When developing preventive interventions, the attitudes of target groups need to be taken into consideration. Therefore, outdoor workers' perceptions and attitudes were investigated. Methods: Seven guided, problem‐centered qualitative interviews with healthy male outdoor workers were conducted. A qualitative content analysis was used to analyze the data. Results: We found an underestimation of the perceived skin cancer risk in the seven outdoor workers and heterogeneous attitudes toward the usage of sun‐protective measures. Participants stated that the feasibility of technical sun‐protective measures depends on the size of the working area. While using a headgear seemed common, none of the participants stated using additional neck protection. Wearing long‐sleeved shirts and long trousers were considered problematic. The interviews revealed important requirements for sun‐protective clothes, especially in terms of different materials. Although the usage of sunscreen was common, our interviewees seemed to apply it wrongly. Conclusion: Risk perceptions of outdoor workers and their attitudes toward sun protection measures may influence the factual UV protection behavior in the workplace. Structures to facilitate the implementation of technical and organizational sun‐protective measures seem to be necessary. Educational interventions and clear instructions which are tailored to the individual needs and attitudes of outdoor workers are required to improve the UV protection behavior and to avoid common mistakes. [ABSTRACT FROM AUTHOR]

Keywords: allergic contact dermatitis; case report; dithiocarbamates; gloves; nitrile/neoprene rubber; polyethylene; rubber accelerators; thiurams EN allergic contact dermatitis case report dithiocarbamates gloves nitrile/neoprene rubber polyethylene rubber accelerators thiurams 321 322 2 03/16/22 20220401 NES 220401 CASE REPORT A 44-year-old woman with atopic diathesis who worked as a cleaner of hospital beds presented with longstanding hand dermatitis. The shorter PE glove - despite having almost the same length as the disposable protective glove - tended to slip causing direct skin contact at the wrist with the protective glove containing dithiocarbamates (Figure 1C). [Extracted from the article]

Allergic contact dermatitis, case report, cetylpyridinium chloride, hand eczema, healthcare workers, patch test, surgical gloves, 1,3-diphenylguanidine In conclusion, DPG and, if possible, CPC should be patch tested in healthcare workers with suspected allergic contact dermatitis who use sterile surgical gloves. Keywords: 1,3-diphenylguanidine; allergic contact dermatitis; case report; cetylpyridinium chloride; hand eczema; healthcare workers; patch test; surgical gloves EN 1,3-diphenylguanidine allergic contact dermatitis case report cetylpyridinium chloride hand eczema healthcare workers patch test surgical gloves 207 208 2 02/25/21 20210301 NES 210301 CASE REPORT A 55-year-old male anaesthesiologist with hand eczema was patch tested in our department in 2016 revealing sensitization to 1,3-diphenylguanidine [DPG, day (D) 3: +] and cetylpyridinium chloride (CPC, D3: +). [Extracted from the article]

Background Objectives Methods Results Conclusions Comfort gloves are used in the management of hand dermatoses.To compare the acceptance and tolerability of comfort gloves made of different materials in patients with hand dermatoses and their effects on skin lesions.In a prospective multicenter study, 284 patients with hand dermatoses were invited to wear either a cotton glove (COT) or a semipermeable Sympatex glove underneath a cotton glove (SYM/COT) for two subsequent phases of 19 consecutive nights each. A total of 88 controls were asked not to wear any comfort gloves overnight. The severity of skin lesions over time was examined. Questionnaires were used to assess health‐related quality of life (HRQoL) and acceptance and tolerability of the gloves.The hand dermatoses improved in all groups. No substantial intergroup differences regarding severity and HRQoL were observed. SYM/COT received better ratings regarding climate conditions and tactility while COT showed superiority in fit, wearing comfort, and practicality.We confirmed that SYM/COT and COT are well tolerated and accepted suggesting that SYM/COT is a good alternative for COT as comfort gloves in patients with hand dermatoses. Individual requirements, needs, and preferences may direct the material choice. [ABSTRACT FROM AUTHOR]